Thursday, August 25, 2011

Behind Bars Without Help: The Mental Health Controversy in Michigan

By Ron Honberg, NAMI Director of Policy and Legal Affairs

The new head of Michigan's Department of Corrections recently made national news when he expressed concerns about the extent to which his department's resources are used to provide mental health to inmates.

On August 21, it was reported in the Detroit News that Dan Heyns, director of Michigan's Department of Corrections wanted to work with sheriffs, prosecutors and local officials to ensure that fewer people living with mental illnesses come to prison.

"I've got institutions that are just packed with people who are very, very seriously mentally ill", Heyns said. "These aren't stress cases. I can't exactly provide a therapeutic environment."

Jails and prisons are the worst possible environments for people struggling with the symptoms of severe mental illnesses. Prisons are ill-equipped to provide effective psychiatric treatment. Inmates with the most severe mental illnesses are too often isolated in administrative segregation, special housing units, super-max prisons and other forms of solitary confinement. The long term isolation of individuals experiencing delusions, hallucinations or other severe psychiatric symptoms has been characterized as being akin to torture.

Sadly, the problems highlighted by Director Heyns are not unique to Michigan. A recent study revealed that about 17.1 of male inmates and 34.3 percent of female inmates in local jails throughout the country live with a serious mental illness such as schizophrenia, bipolar disorder or PTSD. When compared to figures for the general population this is roughly a 470 percent increase in prevalence for both men and women.

So what can be done to achieve Director Heyns vision that fewer individuals living with mental illnesses come to prison to begin with?

Some would respond that we need to take a close look at our nation's treatment laws. Until the 1960s, people living with serious mental illnesses were virtually devoid of civil rights protections and were frequently institutionalized for long periods of time with no due process or right to appeal. Fortunately, these egregious civil rights abuses are a thing of the past.

There are many who believe that the laws have gone too far in the other direction, asserting that requiring proof of immediate or imminent danger to self or others means that certain people will not get help when they need it the most. Not everyone agrees. Many argue equally strenuously that the laws should remain as they are, citing continuing abuses and civil rights violations in hospitals, adult care homes, and other settings as evidence that we need to maintain strict, narrow civil commitment standards.

Irrespective of how you feel about these complex issues, the overall lack of mental health services and supports across the country is beyond dispute. Even during the best of economic times, the availability of good mental health services has been limited in the US, particularly for those who rely on the public mental health system for their care. In 2006 and 2009, before the full impact of the economic crisis, NAMI gave the nation's mental health system a grade of "D" in its Grading the States 2006 and 2009 reports.

Unfortunately, the economic recession has only made these problems worse. In March, 2011, NAMI released a report entitled State Mental Health Cuts: A National Crisis. This report revealed cuts to non-Medicaid state mental health spending of nearly $1.6 billion dollars between 2009 and 2011, with even deeper cuts projected for 2012. These cuts have led to the erosion of vital inpatient and community services for tens of thousands of youth and adults living with the most serious mental illnesses. Hospital beds have been eliminated and in many parts of the country, there are virtually no community services available either.

Not surprisingly, these cuts have added to already considerable burdens faced by law enforcement and correction centers. In Nevada, Judge Jackie Glass, who runs the Clark County (Las Vegas) Mental Health Court implored legislators not to impose further cuts on mental health services. She testified that "you will see … people [who lose mental health services] ending up in prisons, jails, emergency rooms, homeless…"

In Sacramento County, California, U.S. District Court Judge John A. Mendez went further, blocking the county from cutting mental health services as a way to balance the budget. He stated that the county's budget cutting plan would cause "catastrophic harm" and violate the Americans with Disabilities Act (ADA).

The U.S. is clearly at a pivotal moment in its history. Solutions to the budget crisis are not easy. However, one thing is clear: Indiscriminate cuts to mental health budgets will not save money, but cost more in the long run. Cuts of the magnitude that have occurred will continue to perpetuate the national disgrace of incarcerating people for the "crime" of having a serious mental illness. We should pay heed to Director Heyns, Judge Glass, Judge Mendez and others on the front lines responding to people in crisis. A civilized, advanced nation must do better for its most vulnerable citizens.

21 comments:

Anonymous
said...

I agree that people with a mental illness should not be placed in prison. The trouble with prisons is that they do not always provide a safe and therapeutic environment from others and from themselves.

Thanks, Ron. This director's reaction is consistent with the prior two directors in Michigan. We made similar comments in testimony to the recent plan for handling care for people with dual eligibility. That is, no plan will succeed without a strong link to the communal justice system.

Right now, my mom is in jail in upstate NY, after having been arrested for harassment while having a bipolar episode. Within a week and a half of her arrest, the jail lost the judge's order for psychiatric evaluation! It took nearly a month to have her transferred to a psych. center, if she even has been transferred at all; because of privacy laws, staff at the jail and hospital will not tell the family exactly where she is, or if she has indeed been transferred. I'm extremely frustrated and outraged at the state of disconnection within family created by the infrastructure of this country and complicated litigation. On top of that, I am out of state, therefore limited as to what I can do. Any advice? Encouragement... Please!

As a mental health professional in a county jail, I can personally attest to the influx of the severely and persistently mentally ill. It is an outrage that as a society we are chipping away at the bare minimum of services this population can access. When we stop taking care of our disabled and our elderly, we start our inevitable demise. Thanks for posting.T

Thank you so much for this article and the attention to this population. My husband is in prison after a severe manic crisis. He has a long history of larceny all resulting from undiagnosed bipolar disorder. He had just been diagnosed and started treatment when an accident landed him in the hospital. He had 2 surguries and 8 different infections. While he was hospitalized I told 16 different Drs and countless nurses we had to monitor him carefully due to the treatment including high amounts of narcotics and an already unstable mental condition. Instead of quality care we were treated like we were less than dirt. He was nothing but a junkie and mental case. Even the psychiatrist was oblivious to his needs. To add insult to injury, I am an RN working for the hospital he was at. Long story short, he was discharged from the hospital while on narcotics and mentally unstable and ended up going missing for 4 weeks, when the police found him he was literally almost dead. They took him back to the same hospital and the same Drs put him back on narcotics, even the psychiatrist said to him you cant use drugs if your bipolar. Yet they still didnt take him off the drugs and get him stable. Instead they discharged him to jail where he detoxed without medical supervision and ended up with a large blood clot lodged half in his heart the other half in his lung. Fortunately he was taken to a different hospital where the Drs treated his illness and not the stereotype. They saved his life, they gave me my husband back and my daughter her father. He was later sentenced to 2 years for larceny in a building, the take... less than $50.00. He was sentenced that way because of his history, over 20 years without a diagnosis and treatment his episodes played out ending in him getting caught stealing. Pretty small amounts, all crimes of convienience. But it all caught up to him and instead of initially getting proper treatment he got a criminal record. Dont get me wrong, we both know that what he did was wrong, its the solution that is wrong right now. He needs treatment not punishment. Imagine if we sent everyone with diabetes to jail and told them to think about thier behavior and just balance thier blood sugar by having good thoughts and making good choices. Not real practical is it? Niether is incarcerating the mentally ill. That being said, he is for the first time feeling good about himself and feeling he has some control over his mind because he has made significant progress due to the care he has recieved from the mental health professionals within the MDOC. We are greatful for this time because it saved his life and got him the treatment he has needed for decades. Whats so maddening is that this should have happened as a civilian, his daughter shouldnt be growing up without him and he shouldnt be caged amoung violent sex offenders and murderers. There needs to be an alternative that offers treatment in a safe and positive environment. We need to create a mental health institute to help treat those with criminal charges and help them prevent this from happening again. It can be a secured location and needs to address the behavior but first it must address the cause. One more thing, he cant participate in the intensive drug abuse program in the MDOC because you cant be on mental health services and go through the program, the programs director states its a conflict of interest. But the vast majority of addiction stems from untreated or undertreated mental illness. The state has spent literally hundreds of thousands of dollars on my husband over the years because the treatment was missing the problem. Lets cut the crap and the spending and get to the source of the problems and treat those, not the actions alone.

A former correction counselor in the NYS system. I understand the problems which is "the fine line". If a person with a MH disorder/s cannot control his activity in the greater community or has no MH support system there open to the only other system left. Correction, which means to correct. We all know what that mean. The fine line is reframe from criminal activity and attempt to obtain help. For the most part one will not need to be corrected. Assisted yes, not corrected.

I'm a Mother who has a son with a Mental Illness who has been in Jail since June-25-2009 the first week he was there, two guard's put another inmate into his ceil and almost beat him to death.My son is still there as of today,the system we know, it is no place for the mental ill, they are treated like dog's.The guard's have no education on Mental illness, I have two lawyers and still nonthing done, something is wrong with our system when you have two lawyers, and my son is still there. Just a short comment,I stand to be my son's voice and deeply trouble BY THE SYSTEM.Terry B.

It's worse than that. I was sent to an ER for help with depression. I was involuntarily commmitted for several weeks on the recommendation of a "screener" and forced to pay for the commitment myself. Theoretically you're entitled to a hearing before a judge in NJ, but it takes up to 2-3 weeks to arrange this--it cost me tens of thousand of dollars for a hospital stay that long.

I would repost this on my Linked In Group for the California NEvada Chapter of American Correctional Health Services, and my facebook group for the same jailnurse page and Twitter accounts,if your webpage had the capacity to shre theses types of articles through social media, getting the word out is imperative. Furthermore, NAMI Rocks! Go Forensic Group! ~JAILNURSE

My husband was dragged out of his truck and thrown in jail for trying to commit suicide. I called the police for help to save him. I knewthe bridge he would drive off. They approached without lights and he never knew they were there until he tried to move his truck. Then it turned into a nightmare - guns drawn,(not him) he was in his underwear severly depressed and suicidal.They ,two police cars surrounded his truck broke out the drivers window drageed him out, punched him , threw him to the ground and put him in jail .Charged with two felony counts, We are still in the court process. He went without his medication for two days until I could get bail money and take him to the hospital to get the proper help. I don't know why they didn't send the PERT TEAM. They are trained for this type of situation. It's exteremly sad that someone who is trying to take their own life is now charged with two felonies and if convicted would have TWO STRIKES under CA law because of a severe depressive break.

Thank you for the article and Thank You for the many touching and heart wrenching stories about loved ones with mental illness who are in jails and prisons.

I am a retired physician who lives in Longmont, CO. In 2007 I asked a psychologist friend's houseguest to call the Boulder police for me for help: they proceeded to break my scapula, damage both of my hands and the nerves in my hands, and then had the audacity to create a false report and throw me in jail, with 2 counts of felony and 2 counts of misdemeanors.

I have never had a problem with law enforcement in my entire life. I was 57 at the time. I have not had any problems since, except for the toll on my life.

It cost me $30,000 to have the charges dismissed against me for lack of 'mens rhea'. If I hadn't been suffering from severe Post Traumatic Stress Disorder (P.T.S.D.) from what the police had done to me that night in 2007, I would have insisted that all of the charges be dropped and my record completely cleared.

The problems facing people with mental illness and their families and loved ones are:1.Lack of knowledge by our poorly trained law enforcement Officers and society as a whole.2. The Prejudice and Stigma of our Law enforcement Officers and our society at large.3. The failure to recognize that people with mental illness frequently have their civil rights taken away BEFORE they are entered into the criminal justice system because of the way they are treated by our society and by the police and other law enforcement agencies..4. After a person with mental illness is entered into the criminal justice system they frequently can not receive the appropriate treatment or legal representation and the police are believed over the person with the mental illness.

I went to 40+ lawyers for assistance with my case and ALL of them said they couldn't win in a court of law because the jury "always believes the law enforcement officer" over the person with mental illness. After all, that person is supposed to be "crazy".

We need to start a political movement in our country to protect our citizens with mental illness and their families and loved ones.

You will never be able to imagine the shock, the heartache, the destruction of my soul and spirit, and the life altering effect I have suffered at the hands of the Boulder Police in Boulder, Colorado. I went to a friends house and asked her house guest to call the police FOR ME. Because I have a mental illness and because of the police's ignorance, prejudice, arrogance, and poor training, I ended up with:1. A fractured right scapula, a bone that is almost impossible to break.2. Nerve damage to both of my hands.3. Being jailed.4. A criminal record even though I was not guilty of the fabricated charges brought against me by the police.

If this can happen to a well respected Physician, you can imagine what is happening in our communities across the Unites States. It is even more egregious because Police Officers and Doctors typically have great respect for one another because of the jobs we do and the potential that any doctor might be the one who might save an officer's life. But not in Boulder, Colorado, where the police are known for their sadistic treatment of people with mental illness- sadistic to the point that mental health caregivers themselves are afraid to speak out for fear that they, too, will be targeted at a later date by the police.

I welcome your comments and suggestions on how we, as a segment of our society, can pull together and be heard. My current life is devoted to the cause and I believe it needs to be heard at the National level, every day, until society at large and our Federal Government is willing to take steps to change the horrific condition in our society.

My son has not improved any with his mental illness and Asperger Syndrome in over 4 years in prison. However the judges and prosecutors think that punishment will deter crimes. History will judge their actions in a very unfavorable light. “If societies are judged by how they treat their most disabled members. Our society will be judged harshly indeed,” said E. Fuller Torrey M.D., a research psychiatrist and Treatment Advocacy Founder.

In response to anonymous who said the PERT team was not called, there are not a lot of PERT teams so I think this happened in Orange or San Diego County. If San Diego, please follow up by filing a complaint with the Sheriff's department and the Citizens' Review Board. That is how things change!

We were left w/no options when our family member assaulted me, being psychotic and manic w/schizophrenia, and abusing crack. Other laws had been tried, and failed, and we wanted her off the streets. She was found incompetent and had great care at our state hospital, where she stabilized. If we could have only had a civil commitment there before the decompensation and other failed attempts for help. There has to be locked downs besides Jail/prison & laws w/teeth to provide patients with a long term solution other than waiting for the worst to happen. We have had a good outcome, and are thankful for the jail recognizing her need to be in a "special needs" section and not in general population. She ws accepted to an ACT team upon release in chg of her care, because the community mental health center had exhausted all their resources for her. Taking one day at a time.

To You have Got to Love IT. We have a smiliar issue that happened with the boulder police dept. My son is in has post traumatic stress syndrome. It is a long story and we could use your help or advice. I am not sure how to contact you. We had a lawyer that did nothing but tell my son not to go to jury trial because they would not believe the likes of him. I really need help to save my son, he is not in jail but might as well be because they took his life away, his license and his will to go on. I hope you read this and will post how I can contact you.

I have read many of the comments after the original article. I am a licensed, clinical psychologist who is also mentally ill. I have bipolar disorder and from 2007 through 2010 was hospitalized on 13 separate occassions due to suicidal thoughts or behavior. I worked with the mentally ill as a clinician and advocate for 20 years before having to retire because my illness prevented me from dealing with the daily stress of work and continued to send me to inpatient psychiatric units. The hospitals aren't much better than jail in my personal view. Patients are treated very much like prisoners. The "mental health technicians" as they are called have little to no education and only some hospital or state sponsored training akin to group home training, yet, they really run the show. Doctors are only there briefly each day to spend 5 minutes with each patient, the nurses stay behind the counter and the doors and simply pass medications, the social workers show their faces once a day for what is often a rather tenuous and meager "group therapy" session. Other than that, the technicians tell you when to get up, when to eat, when to have leisure time, when to go to groups, when to go to bed, when to shower, etc. Many of whom do so with little to no degree of respect or dignity toward their patients. Indeed, I am a doctor and, aside from a few MD's and one social worker I can remember, not one person in all my hospitalizations has every referred to me as such. I even told one group of staff at one hospital that I preferred to be called by my first name or Dr. (last name) rather than Mr. (last name). From that point on, they went out of their way to call me Mr! After that, I rarely told anyone my educational or work background except during the psycho-social assessment that almost always occurred at the end of my stay rather than at the beginning as it should have occurred. Chelsea Hospital and Owosso's hospital are the best possible choices for those seeking inpatient treatment in Mid Michigan. I've been to them all it seems and these two were the best. In any case, back to the original discussion. In order to change the situation regarding mental illness in correctional facilities, we must first change the discourse. In other words, mental illness must be given parity with physical illness by insurance companies, health care providers, and policy makers. Once mental illness is seen and acted upon as the same thing as physical illness, than we can make giant leaps in the social and political landscape. The State of Michigan had a bill several years back that addressed mental health parity, but I am quite certain it did not pass. Rather than trying to develop a huge grassroots movement that can be difficult to organize and sustain, each of us can call our state congress person and senators as well as our federal congress persons and senators. Let them know we demand mental health parity from our insurance companies, health care providers, courts, law enforcement, etc. Encourage them to support passing legislation that does this. Finally, community mental health boards often have jail liasons. If you have a loved one in jail due to a mental illness related charge, contact your local CMH and ask for the liason. Ask him or her to meet with your loved one and determine if he or she would benefit from a case manager and, if, he or she qualifies for this higher level of care, much can be done to get the person's case from regular court to mental health court, get them released, and get them the treatment they deserve. Good luck all!

I read all your BLOGS thank you. My son was hit and almost killed by a drunk/drugged driver when he was 3yrs old. He has had emotional/mental disability ever since then. Been in and out of jail several times.He was on medication all his life. Now looking at prison time. the community mental health in Michigan is irresponsible; neglectful; and ignorant. My son tried to commit suicide several times. I requested hospitalization but denied. Since when does a person with mental illness know whats best for them in a mental state of mind. my son has pdst,bi-polar disorder,borderline personality disorder, and if he gets unlucky he'll inherit my schiziphrania. I would be more then happy to join an organization or group willing to fight for people with mental illness.